Section 388-106-0135 - What are the maximum hours that I can receive for in-home services?(1) If you are age 21 or older, the maximum number of hours that you may receive is the base hours assigned to your classification group and adjusted per WAC 388-106-0130, unless additional hours are authorized through an exception to rule per WAC 388-440-0001. For chore program clients, the maximum personal care hours per month the department will authorize is one hundred sixteen (116).(2) If you are under age twenty-one: (a) The maximum number of hours that you may receive will be the base hours assigned to your classification group and adjusted per WAC 388-106-0130, unless additional hours are authorized under parts (2)(b) or (3) below.(b) Additional hours may be authorized at the department's discretion through an exception to rule per WAC 388-440-0001. You may request additional hours of personal care services through an exception to rule by contacting your case manager and explaining why you do not believe the authorized hours provide adequate assistance with your personal care tasks. The case manager will document your request and forward the request for review per WAC 388-440-0001. You will be notified in writing of the decision.(3) If you are under age twenty-one, the department will authorize additional hours of personal care services beyond those authorized under section (2) according to the limitation extension process described below. If the evidence shows that additional personal care assistance is necessary to correct, improve, or prevent further deterioration of your condition, the department will authorize additional hours in the amount required to fully complete your ADLs or IADLs. (a) You may request a limitation extension in writing within 90 days after you have received the department's written decision under subsection (2)(b); or if 30 days have passed since you requested an exception to rule under subsection (2)(b) and you have not yet received a written decision from DSHS.(b) You may submit any evidence to show that additional hours of personal care are necessary. The following evidence should be provided: (i) An explanation of the hours necessary to complete your ADLs and IADLs;(ii) Documentation of the supports available to you over the course of a week; and,(iii) An explanation of why informal supports are unavailable to provide the additional assistance you are requesting. When you are living with your legally responsible parent, the considerations described in WAC 388-106-0130(8)(d) apply to the determination of availability of informal supports.(c) If requested by the department, you must also provide additional documentation of your situation. If requested documents are not reasonably available to you without cost and/ or if you need assistance from the department to obtain the requested documents, you must provide written permission to the department to obtain the documents on your behalf. Documents that the department may ask for include the following: (i) Your most recent Individualized Educational Plan (IEP), if you are still in school.(ii) Treatment plans for clinically recommended treatments relevant to your personal care services, such as active range of motion, passive range of motion, bowel program, etc.(iii) Documents indicating residential time with your noncustodial parent or the availability of a noncustodial parent to provide assistance, such as parenting plans or child support orders. If those documents do not accurately reflect the supports currently available to you, you may also submit information or documents describing the support actually provided by your non-custodial parent.(d) The department may also require a further review of your functional ability to perform specific ADLs and IADLs, to be conducted at the department's expense. The review must be completed under WAC 182-551-2110 by a qualified occupational therapist. If a qualified occupational therapist is not available to complete the review, the department will designate another qualified healthcare professional to complete the review.(e) Upon receiving your request for a limitation extension and any additional supporting information you choose to submit under subsection (3)(b), the department will make a decision according to the timeline below. (i) The department will make a decision under subsection (3) within 30 days unless additional information is required under subsections (3)(c) and/or (3)(d).(ii) If additional information is required under subsections (3)(c) and/or (3)(d), the department will notify you of what additional information is required within 30 days of the date the department received your request and supporting information, if any. The department will then make a determination under subsection (3) within 15 days of either of the following, whichever comes first: (A) The date that the department receives all of the requested information, including a report of any review of your functional ability conducted under subsection (3)(d); or,(B) The date that you notify the department that you will not be providing any additional information.(f) Additional hours will not be approved to substitute for the duties of legally responsible adults, replace childcare or school, replace recommended equipment available through Medicaid, or provide supervision other than task-specific supervision necessary for you to perform an ADL or IADL.Wash. Admin. Code § 388-106-0135
Amended by WSR 14-10-077, filed 5/6/14, effective 6/26/2014Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0135, filed 5/17/05, effective 6/17/05.